Wound

1. Types
   1. Acute wounds
      1. Surgical wound
      2. Penetrating wound (e.g. knife or bullet wound)
      3. Avulsion Injury (e.g. finger tip amputation)
      4. Crushing or shearing Injury
      5. Burn Injury
      6. Laceration (See Laceration Repair)
      7. Bite wound (e.g. Dog Bite, Cat Bite, Human Bite)
   2. Chronic wounds
      1. Arterial ulcer (Peripheral Vascular Disease)
      2. Venous Ulcer (Venous Insufficiency)
      3. Lymphedema
      4. Pressure Ulcer (Decubitus Ulcer)
      5. Neuropathic ulcer (Diabetes Mellitus)
2. Prognosis: Factors associated with impaired Wound Healing
   1. Chronic Disease
      1. Diabates Mellitus
      2. Peripheral Vascular Disease
      3. Chronic Renal Failure
   2. Malnutrition
      1. See Nutrition in Wound Healing
   3. Immunosuppression
      1. Topical Corticosteroids (e.g. Triamcinolone)
      2. Systemic Corticosteroids over 10 mg per day
      3. Chemotherepeutics (e.g. Methotrexate)
   4. Petrolatum or vaseline (however, good skin protectant)
   5. Topical antiseptics
      1. Topical Alcohol
      2. Hexachlorophene
      3. Povidone-Iodine 1% (Betadine 1%)
      4. Hydrogen peroxide 3%
      5. Chlorhexidine 0.5%
   6. Topical hemostatic preparation
      1. Monsel's Solution (Ferric subsulfate)
      2. Aluminum chloride 30%
      3. Silver nitrate
3. Prognosis: Factors associated with improved Wound Healing
   1. Moisturizing Lotions (e.g. Eucerin, Aquaphor)
   2. Silver sulfadiazine (Silvadene cream)
   3. Topical antibiotic (e.g. Bacitracin)
      1. Avoid neosporin due to Allergic Contact Dermatitis
   4. Nonadherant Dressing (e.g. Telfa)
4. Management
   1. See specific wound types
   2. See Wound Cleansing
   3. See Wound Debridement
   4. See Wound Dressing
5. Course: Wound Healing
   1. Epithelialization (Sealing of wound) by 48 hours
   2. Peak collagen formation by 7 days
   3. Wound tensile strength 20% of full by 3 weeks
   4. Wound tensile strength 60% of full by 4 months
   5. Wound tensile strength never exceeds 80% of full
   6. Mature scar forms by 6 to 12 months
   7. Factors suggesting increased Wound Healing time
      1. See impaired Wound Healing above
      2. Increased wound width
      3. Wounds created by destructive technique
         1. Cryosurgery
         2. Electrosurgery
         3. Laser surgery
6. References
   1. Bello (2000) JAMA 283(6): 716-8
   2. Degreef (1998) Dermatol Clin 16(2): 365-75
   3. Findlay (1996) Am Fam Physician 54(5): 1519-28
   4. Habif (1996) Clinical Derm, Mosby, p. 810-13
   5. Knapp (1999) Pediatr Clin North Am 46(6):1201-13
   6. Krasner (1995) Prevention Management Pressure Ulcers
   7. Lewis (1996) Med-Surg Nursing, Mosby, p. 199-200
   8. Lueckenotte (1996) Gerontologic Nurs., Mosby, p. 800-7
   9. PUGP (1995) Am Fam Physician 51(5):1207-22
   10. PUGP (1994) Pressure Ulcer Treatment, AHCPR 95-0653
   11. Way (1991) Current Surgical, Lange, p.95-108